Privacy Notice

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

NOTICE FOR USE AND SHARING OF PROTECTED HEALTH INFORMATION

We at Finesse Cosmetic Laser and Lipo Center pledge to give you the highest quality health care, and to have a relationship with you that is built on trust. This trust includes our commitment to respect the privacy and confidentiality of your health information.

This Notice is being given to you because federal law gives you the right to be told ahead of time about:

How Finesse will handle your medical information.

Finesse’s legal duties related to your medical care.

Your rights with regard to your medical information.

HOW WE MAY USE AND DISCLOSE (SHARE) YOUR PROTECTED HEALTH INFORMATION

When you have a treatment or procedure, you give information about yourself and your health to doctors, nurses, and staff. This information, along with the record of the care you receive, is “protected health information” (or “health information”). The information in your medical record is kept in paper form and/or in an electronic form on the computer.

Finesse uses your health information within its system and shares your health information outside its system in order to give you excellent medical care. Finesse uses and shares your health information for other reasons that can include training new staff and improving our quality of care.

Finesse may share your health information with outside health care providers for purposes such as treatment or research. This Notice tells you how Finesse uses and shares your health information for these and other purposes. It also tells you when we need to get your specific permission to do so.

Treatment, Payment, and Health Care Operations

Except where prohibited by Massachusetts state or federal laws, Finesse may legally use and share your health information for treatment, payment, and health care operations. We do not need to ask for your specific permission to do these things, as explained below:

Treatment

Finesse health care providers will use and share your health information to provide and manage your health care and related services. For example, your doctor may refer you to a specialist such as a radiologist or surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the doctors in this example, whether they are in the Finesse system or not, will share medical information about you. This is to coordinate your care before, during and after you go into the hospital. Finesse will share information with other third parties, such as home health agencies, visiting nurses, rehabilitation hospitals, and ambulance companies. It will also share information with those who treated you before you went into the hospital and with those who will treat you in the future. This helps to make sure that everyone caring for you has the information they need.

Payment

Finesse will use and share your health information to bill and collect payment for the services it gives to you. For example, if you wish to use CareCredit we will share your health information with the company so they may check your credit report and to collect payment. Finesse may share your health information with credit card processing companies or other financial institutions to ensure that we receive payment for our services or products.

Health Care Operations

Finesse may use and share your health information for activities that are known as health care operations. These are activities that are needed to operate its facility and carry out its mission. Some of the information is shared with outside parties who perform these health care operations or other services on behalf of Finesse (“business associates”). These business associates must also take steps to keep your health information private. Examples of activities that make up health care operations include:

Monitoring the quality of care and making improvements where needed.

Making sure health care providers are qualified to do their jobs.

Reviewing medical records for completeness and accuracy.

Meeting standards set by regulating agencies, such as, the Joint Commission.

Teaching health professionals.

Using outside business services; such as, transcription, storage, auditing, legal or other consulting services.

Storing your health information on computers.

Managing and analyzing medical information.

Finesse may use your health information to contact you:

At the address and telephone numbers you give to us (including leaving messages at the telephone numbers) about scheduled or cancelled appointments, billing or payment matters, or pre-procedure assessment .

With other health-related benefits and services that may be of interest to you.

With information about patient care issues, treatment choices and follow up care instructions.

Uses and Disclosures (Sharing) of Your Health Information for Other Purposes

Finesse may legally use and/or share your health information with others for the following purposes without your specific permission:

As required by state and federal laws and regulations.

With regard to elder victims of abuse or neglect and in some instances to disabled victims of abuse or neglect.

For public health activities, including required reports to the state public health and child protection authorities, and to agencies such as cancer registries and the federal Food and Drug Administration.

For health oversight activities.

For legal and administrative proceedings.

For law enforcement purposes under specific conditions such as reporting when someone is the victim of a crime.

To avert a serious threat to health or safety.

For specialized government operations.

As authorized by and as necessary to comply with workers compensation laws.

For permissible public health, health care operations, and research purposes when limited identifiable information is used or shared.

Uses and Disclosures (Sharing) You May Ask be Limited, or Request Not Be Made

Disclosures to Family, Friends or Others

Finesse may share relevant health information about you with a family member or other person close to you if they are involved in your care or payment for your care.

Finesse may use or share your health information to notify a family member or other person responsible for you of your location or general medical condition.

If you are present and are able to make health care decisions, we will try to find out if you want us to share this information with your family members or others. If you are in an emergency situation and not able to make your wishes known, we will use our best judgment to decide whether to share information. If it is thought to be in your best interest, we will only share information that others really need to know.

Finesse also may use or share your health information with a public or private agency assisting in disaster relief. This is to coordinate efforts to notify someone on your behalf. If we can reasonably do so while trying to respond to the emergency, we will try to obtain your permission before sharing this information.

Uses or Disclosures (sharing) of Information that Require Your Written Permission (Authorization)

Using and/or disclosing health information for most purposes other than treatment, payment, or health care operations (for example, for many but not all, research and marketing purposes) requires your specific authorization. Furthermore, certain information that may be contained in your medical records is considered by state and Federal law to be highly confidential, including, for example, HIV testing or test information gets additional protection from disclosure, often requiring your written authorization even before disclosing for treatment, payments or health care operations.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION AND HOW TO EXERCISE THEM

The Right to Ask for Limits on the Use and Sharing of your Health Information

You have the right to ask for restrictions on the use and sharing of your health information for treatment, payment, or health care operations. You can also ask for restrictions on using this information to notify you about appointments, etc.

Finesse is not required to agree to your request. If we do, we must put the restriction in writing and abide by it except if you need to be treated in an emergency. You may ask us to restrict uses and sharing of information that we are legally required make.

The Right to Ask that your Health Information be Communicated to you in a Confidential Manner

You have the right to ask for your health information to be sent to you in different ways. For example, you may ask that Finesse not contact you with appointment reminders by telephone, or only call at your work or on your cell number rather than at home.

We may request an address and telephone number(s) to contact you, it is your responsibility to give us telephone numbers and an address that will allow us to carry out your needs to reach you and care for you. We may request that the method and location where you wish to be contacted be in writing and that you contact us with any changes to this information. Finesse must agree to any reasonable request and cannot ask you to explain the reason for your request. Finesse can require you to give information as to how a payment will be handled, and what address a bill should be mailed to.

The Right to Look at and Get a Copy of Your Health Information

You have the right to look at and get a copy of your health information that Finesse keeps of your medical treatment and bills. You must ask for this in writing. We will respond within thirty (30) days from receipt of your request. If you ask for a copy of your records, you may be charged a fee. If your request is denied, we will explain the reasons in writing and tell you which rights you have, if any, for a review of the denial. We may offer to give you a summary or explanation of the information you requested as long as you agree in advance to this and to any fees that it might cost.

The Right to Change Your Health Information

You have the right to ask us to change your health information related to your treatment and bills if you think that there has been a mistake or that information is missing:

You must make your request in writing and give the reason for why you want the change.

We have sixty (60) days to respond to your request.

If we are not able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days.

If we extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response.

If we deny your request, we must give you a written statement with the reasons for the denial, and what other steps are available to you.

If we grant the request we will ask you to tell us the persons you want to receive the changes. You need to agree to have us notify them along with any others who received the information before corrections were made, and who may have relied on the incorrect information to give you treatment.

The Right to Receive an Accounting of Disclosures (Record of When Your Health Information was Shared without Your Written Permission/Authorization)

You have the right to get a record of the times that your health information has been shared. You must make your request in writing. You may request this as far back as seven eight years. The listing you get will include the date, name, and address (if known) of the person or organization receiving your information. It will also include a brief description of the information given, and a brief statement of why the information was shared.

The following exceptions apply:

This does not include sharing your medical information for the purpose of treatment, payment, or health care operations.

It also does not include:

Sharing your medical information if you gave permission in writing (signed authorization form).

Sharing information with persons involved in your care.

Using your information with you about your health condition.

Sharing information for national security or intelligence purposes or to correctional institutions or law enforcement officials who have custody of you.

We have 60 days to respond to your request. If we have not been able to act on the request within the 60 days, we will notify you that we’re extending the response time by 30 days.

If we do extend the response time, we will explain the delay to you in writing and give you a date of when to expect a response.

Your first request for a record in any 12-month period is free.

We will charge a fee for any other requests in that period.

We will notify you of the fee before we do the work. This will give you a chance to stop the request if you do not wish to pay the fee.

The Right to Ask for a Paper Copy of this Notice

You may ask for a paper copy of this Notice from the contact listed at the end of the Notice.

OUR DUTIES WITH RESPECT TO YOUR HEALTH INFORMATION

Finesse is required by law to keep your heath information private. We are required to give people notice of our legal duties and privacy practices with respect to your health information. Finesse must abide by the terms of the Notice currently in effect. Finesse reserves the right to change its privacy practices and the terms of this Notice any time. Finesse reserves the right to make the new Notice provisions effective for all protected health information. If done so, the updated Notice will be posted on the Finesse web site and in Finesse’s facility for public viewing. You may request a copy of the current Notice at any time by calling any of the people listed at the end of this notice, or you may view it on our web site at www.finesselaser.com.

RETENTION AND DESTRUCTION OF HEALTH INFORMATION

Finesse Cosmetic Laser and Lipo Center is required to keep your medical records for seven years, however after a period of two years of inactivity, we may choose to place your medical file in a secured offsite storage facility. This storage facility will be limited to access by Finesse Cosmetic Laser and Lipo Center employees and its representatives only.

We destroy paper files containing personal information by shredding. We destroy electronic information by deleting it and when the hardware is discarded we ensure that the hard drive is physically destroyed and beyond repair.

HOW TO COMPLAIN IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED

If you think that we may have violated your privacy rights or you disagree with any action we have taken with regard to your health information, we want you, your family, or your guardian to speak with us. If you present a complaint, your care will not be affected in any way. It is the goal of Finesse Cosmetic Laser and Lipo Center to give you the best care while respecting your privacy.

You may file a complaint by contacting a representative at Finesse Cosmetic Laser and Lipo Center. You may also send a written complaint to the US Departments of Health and Human Service, JFK Building – Room 1875. Boston MA 02203, voice phone at 617.565.1340, or email to OCRComplaint@hhs.gov. We will take no retaliatory action against you if you file a complaint about our privacy practices.

PERSON TO CONTACT FOR INFORMATION OR WITH A COMPLAINT

Peter Kruy, MD

Managing Directing

-OR-

Nicole Billings

Clinic Manager

781-899-7546

If you have any questions about this Notice or any complaints, please contact a representative at Finesse Cosmetic Laser and Lipo Center.